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Sinai A, Nassar M, Shornikov L, Constantinescu M, Zaaroor M, Schlesinger I. Focused Ultrasound Thalamotomy for Tremor Relief in Atypical Parkisnsonism. Parkinsons Dis 2024; 2024:6643510. [PMID: 38476865 PMCID: PMC10932618 DOI: 10.1155/2024/6643510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/04/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
Background Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) VIM-thalamotomy has established efficacy and safety in tremor relief in patients with essential tremor and Parkinson's disease. The efficacy and safety in patients with atypical parkinsonism have not been reported. Objective To report on the efficacy and safety of FUS VIM-thalamotomy in 8 patients with parkinsonism, multiple system atrophy-Parkinsonian type (MSA-P) (n = 5), and dementia with Lewy bodies (DLB) (n = 3). Methods Tremor was assessed in the treated hemibody using the Clinical Rating Scale for Tremor (CRST). The motor Unified MSA Rating Scale (UMSAR) was used in the MSA-P and motor sections of the Unified Parkinson's Disease Rating Scale (UPDRS-III) in DLB patients. Cognition was measured using the Montreal Cognitive Assessment (MoCA). Results In MSA-P and DLB patients, there was immediate tremor relief. CRST scores measured on the treated side improved compared to baseline. During the follow-up of up to 1 year tremor reduction persisted. The change in CRST scores at different time points did not reach statistical significance, probably due to the small sample size. Adverse events were transient and resolved within a year. Conclusions In our experience, FUS VIM-thalamotomy was effective in patients with MSA-P and DLB. Larger, controlled studies are needed to verify our preliminary observations.
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Affiliation(s)
- Alon Sinai
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Maria Nassar
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Lev Shornikov
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | | | - Menashe Zaaroor
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
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Makawita C, Ananthavarathan P, de Silva R, Malek N. A Systematic Review of the Spectrum and Prevalence of Non-motor Symptoms in Multiple System Atrophy. Cerebellum 2024:10.1007/s12311-023-01642-1. [PMID: 38227270 DOI: 10.1007/s12311-023-01642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Patients with Multiple System Atrophy (MSA) frequently report non-motor symptoms, and several research groups have highlighted this. OBJECTIVE We systematically searched for and reviewed papers assessing prevalence of non-motor symptoms (NMS) in MSA patients as reported in the scientific literature. METHODS We performed a systematic review of studies of subjects with MSA (involving > 10 patients) who were assessed for NMS, published in the English literature in PUBMED and EMBASE databases from 1947-2022. RESULTS 23 research papers, with data from 2648 clinically diagnosed and 171 pathologically verified cases of MSA were included, along with 238 controls. Mean age for MSA cases was 61.3 (9.2) years, mean disease duration 3.6 (2.7) years. 57.9% were male. Our analysis showed that the prevalence of cognitive issues in MSA varied widely (between 15-100%); dementia per se was uncommon, but assessment in advanced stages of MSA is impacted by unintelligible speech (which may be noted in a quarter of cases). The prevalence of depressive symptoms in MSA was between 44-88%. Sleep disturbances were reported by 17-89%, with REM-sleep behaviour disorder (RBD) rates as high as 75%. Pain was reported by 40-47% of patients: rheumatic or musculoskeletal sources of pain being commonest. Fatigue was reported by 29-60% of patients. Symptoms of autonomic failure in MSA were seen in 34-96.5% patients at baseline. CONCLUSION In routine clinical practice, NMS in MSA are under-recognised by clinicians. These impact hugely on patient quality of life and contribute to their overall morbidity. A methodical ascertainment of these complaints will address an unmet need, and lead to a more holistic approach of care for individuals with MSA.
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Affiliation(s)
- Chulika Makawita
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex, RM7 0AG, UK.
| | | | - Rajith de Silva
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex, RM7 0AG, UK
| | - Naveed Malek
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, Essex, RM7 0AG, UK
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Villena-Salinas J, Ortega-Lozano SJ, Amrani-Raissouni T, Agüera-Morales E, Caballero-Villarraso J. Comparative Study between the Diagnostic Effectiveness of Brain SPECT with [ 123I]Ioflupane and [ 123I]MIBG Scintigraphy in Multiple System Atrophy. Biomedicines 2024; 12:102. [PMID: 38255208 PMCID: PMC10813386 DOI: 10.3390/biomedicines12010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disease. It has a fast progression, so early diagnosis is decisive. Two functional imaging tests can be involved in its diagnosis: [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. Our aim is to comparatively analyze the diagnostic performance of both techniques. METHODS 46 patients (24 males and 22 females) with MSA underwent [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. In each of these techniques, qualitative assessment was compared with quantitative assessment. RESULTS SPECT visual assessment was positive in 93.5% of subjects (S = 95.24%; PPV = 93.02%). A cut-off of 1.363 was established for overall S/O index (S = 85.7%, E = 100%). Visual assessment of scintigraphy was positive in 73.1% (S = 78.57%, PPV = 94.29%). For the delayed heart/medistinum ratio (HMR) a cut-off of 1.43 (S = 85.3, E = 100%) was obtained. For each unit increase in delayed HMR, the suspicion of MSA increased by 1.58 (OR = 1.58, p < 0.05). The quantitative assessment showed an association with the visual assessment for each technique (p < 0.05). CONCLUSIONS Both tests are useful in MSA diagnosis. Comparatively, we did not observe a clear superiority of either. Striatal and myocardial deterioration do not evolve in parallel. Qualitative assessment is crucial in both techniques, together with the support of quantitative analysis. Delayed HMR shows a direct relationship with the risk of MSA.
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Affiliation(s)
- Javier Villena-Salinas
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.V.-S.); (S.J.O.-L.); (T.A.-R.)
| | - Simeón José Ortega-Lozano
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.V.-S.); (S.J.O.-L.); (T.A.-R.)
| | - Tomader Amrani-Raissouni
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.V.-S.); (S.J.O.-L.); (T.A.-R.)
| | - Eduardo Agüera-Morales
- Neurology Service, Reina Sofia University Hospital, 14004 Cordoba, Spain;
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Javier Caballero-Villarraso
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
- Clinical Analyses Service, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Biochemistry and Molecular Biology, Universidad of Córdoba, 14071 Córdoba, Spain
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Saulnier T, Fabbri M, Pavy-Le Traon A, Le Goff M, Helmer C, Péran P, Meissner WG, Rascol O, Foubert-Samier A, Proust-Lima C. Disease Progression in Multiple System Atrophy: The Value of Clinical Cohorts with Long Follow-Up. Mov Disord 2023; 38:1567-1569. [PMID: 37565400 DOI: 10.1002/mds.29534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Tiphaine Saulnier
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
| | - Margherita Fabbri
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital,InsermU1048/1214, Toulouse, France
| | - Anne Pavy-Le Traon
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital,InsermU1048/1214, Toulouse, France
| | - Mélanie Le Goff
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
- Inserm,CIC1401-EC, Bordeaux, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univ Toulouse, Inserm, UPS, Toulouse, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc,CRMRAMS, NS-Park/FCRIN Network, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, Bordeaux, France
- Department Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Olivier Rascol
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital,InsermU1048/1214, Toulouse, France
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
- Inserm,CIC1401-EC, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc,CRMRAMS, NS-Park/FCRIN Network, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, Bordeaux, France
| | - Cécile Proust-Lima
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
- Inserm,CIC1401-EC, Bordeaux, France
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Villena-Salinas J, Ortega-Lozano SJ, Amrani-Raissouni T, Agüera E, Caballero-Villarraso J. Diagnostic Effectiveness of [ 123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy. J Clin Med 2023; 12:jcm12103478. [PMID: 37240584 DOI: 10.3390/jcm12103478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder that has no curative treatment. Diagnosis is based on a set of criteria established by Gilman (1998 and 2008) and recently updated by Wenning (2022). We aim to determine the effectiveness of [123I]Ioflupane SPECT in MSA, especially at the initial clinical suspicion. METHODS A cross-sectional study of patients at the initial clinical suspicion of MSA, referred for [123I]Ioflupane SPECT. RESULTS Overall, 139 patients (68 men, 71 women) were included, 104 being MSA-probable and 35 MSA-possible. MRI was normal in 89.2%, while SPECT was positive in 78.45%. SPECT showed high sensitivity (82.46%) and positive predictive value (86.24), reaching maximum sensitivity in MSA-P (97.26%). Significant differences were found when relating both SPECT assessments in the healthy-sick and inconclusive-sick groups. We also found an association when relating SPECT to the subtype (MSA-C or MSA-P), as well as to the presence of parkinsonian symptoms. Lateralization of striatal involvement was detected (left side). CONCLUSIONS [123I]Ioflupane SPECT is a useful and reliable tool for diagnosing MSA, with good effectiveness and accuracy. Qualitative assessment shows a clear superiority when distinguishing between the healthy-sick categories, as well as between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes at initial clinical suspicion.
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Affiliation(s)
- Javier Villena-Salinas
- Nuclear Medicine Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | | | | | - Eduardo Agüera
- Neurology Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Javier Caballero-Villarraso
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
- Clinical Analyses Service, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Biochemistry and Molecular Biology, Universidad of Córdoba, 14004 Córdoba, Spain
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Nakahara Y, Mitsui J, Date H, Porto KJ, Hayashi Y, Yamashita A, Kusakabe Y, Matsukawa T, Ishiura H, Yasuda T, Iwata A, Goto J, Ichikawa Y, Momose Y, Takahashi Y, Toda T, Ohta R, Yoshimura J, Morishita S, Gustavsson EK, Christy D, Maczis M, Farrer MJ, Kim HJ, Park SS, Jeon B, Zhang J, Gu W, Scholz SW, Singleton AB, Houlden H, Yabe I, Sasaki H, Matsushima M, Takashima H, Kikuchi A, Aoki M, Hara K, Kakita A, Yamada M, Takahashi H, Onodera O, Nishizawa M, Watanabe H, Ito M, Sobue G, Ishikawa K, Mizusawa H, Kanai K, Kuwabara S, Arai K, Koyano S, Kuroiwa Y, Hasegawa K, Yuasa T, Yasui K, Nakashima K, Ito H, Izumi Y, Kaji R, Kato T, Kusunoki S, Osaki Y, Horiuchi M, Yamamoto K, Shimada M, Miyagawa T, Kawai Y, Nishida N, Tokunaga K, Dürr A, Brice A, Filla A, Klockgether T, Wüllner U, Tanner CM, Kukull WA, Lee VMY, Masliah E, Low PA, Sandroni P, Ozelius L, Foroud T, Tsuji S. Genome-wide association study identifies a new susceptibility locus in PLA2G4C for Multiple System Atrophy. medRxiv 2023:2023.05.02.23289328. [PMID: 37425910 PMCID: PMC10327266 DOI: 10.1101/2023.05.02.23289328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
To elucidate the molecular basis of multiple system atrophy (MSA), a neurodegenerative disease, we conducted a genome-wide association study (GWAS) in a Japanese MSA case/control series followed by replication studies in Japanese, Korean, Chinese, European and North American samples. In the GWAS stage rs2303744 on chromosome 19 showed a suggestive association ( P = 6.5 × 10 -7 ) that was replicated in additional Japanese samples ( P = 2.9 × 10 -6 . OR = 1.58; 95% confidence interval, 1.30 to 1.91), and then confirmed as highly significant in a meta-analysis of East Asian population data ( P = 5.0 × 10 -15 . Odds ratio= 1.49; 95% CI 1.35 to 1.72). The association of rs2303744 with MSA remained significant in combined European/North American samples ( P =0.023. Odds ratio=1.14; 95% CI 1.02 to 1.28) despite allele frequencies being quite different between these populations. rs2303744 leads to an amino acid substitution in PLA2G4C that encodes the cPLA2γ lysophospholipase/transacylase. The cPLA2γ-Ile143 isoform encoded by the MSA risk allele has significantly decreased transacylase activity compared with the alternate cPLA2γ-Val143 isoform that may perturb membrane phospholipids and α-synuclein biology.
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Kühnel L, Raket LL, Åström DO, Berger A, Hansen IH, Krismer F, Wenning GK, Seppi K, Poewe W, Molinuevo J. Disease Progression in Multiple System Atrophy-Novel Modeling Framework and Predictive Factors. Mov Disord 2022; 37:1719-1727. [PMID: 35668573 PMCID: PMC9540561 DOI: 10.1002/mds.29077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a rare and aggressive neurodegenerative disease that typically leads to death 6 to 10 years after symptom onset. The rapid evolution renders it crucial to understand the general disease progression and factors affecting the disease course. OBJECTIVES The aims of this study were to develop a novel disease-progression model to estimate a population-level MSA progression trajectory and predict patient-specific continuous disease stages describing the degree of progress into the disease. METHODS The disease-progression model estimated a population-level progression trajectory of subscales of the Unified MSA Rating Scale and the Unified Parkinson's Disease Rating Scale using patients in the European MSA natural history study. The predicted disease continuum was validated via multiple analyses based on reported anchor points, and the effect of MSA subtype on the rate of disease progression was evaluated. RESULTS The predicted disease continuum spanned approximately 6 years, with an estimated average duration of 51 months for a patient with global disability score 0 to reach the highest level of 4. The predicted continuous disease stages were shown to be correlated with time of symptom onset and predictive of survival time. MSA motor subtype was found to significantly affect disease progression, with MSA-parkinsonian (MSA-P) type patients having an accelerated rate of progression. CONCLUSIONS The proposed modeling framework introduces a new method of analyzing and interpreting the progression of MSA. It can provide new insights and opportunities for investigating covariate effects on the rate of progression and provide well-founded predictions of patient-level future progressions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Line Kühnel
- H. Lundbeck A/SCopenhagenDenmark
- Department of Mathematical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Lars Lau Raket
- H. Lundbeck A/SCopenhagenDenmark
- Clinical Memory Research Unit, Department of Clinical SciencesLund UniversityLundSweden
| | | | | | | | - Florian Krismer
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Klaus Seppi
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
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Vichayanrat E, Hentzen C, Batla A, Simeoni S, Iodice V, Panicker JN. Lower urinary tract dysfunction in Parkinsonian syndromes. Neurol Sci 2021; 42:4045-4054. [PMID: 34318363 DOI: 10.1007/s10072-021-05411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to outline the clinical presentation, pathophysiology and evaluation of lower urinary tract (LUT) dysfunction in Parkinson's disease and other parkinsonian syndromes including multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy and corticobasal degeneration. RECENT FINDINGS LUT dysfunction commonly occurs in neurological disorders, including patients with parkinsonian syndromes. The pattern of LUT dysfunction and its severity are variable, depending upon the site of lesion within the neural pathways. Parkinsonian syndromes are broadly divided into Parkinson's disease (PD) and a typical parkinsonian syndromes such as multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Different parkinsonian syndromes have distinct clinical features (e.g. dysautonomia, early dementia, supranuclear gaze palsy, higher cortical signs), and the pattern of LUT dysfunction and its severity can differ. CONCLUSIONS LUT dysfunction is a common feature in patients with parkinsonian syndromes. Recognising the pattern of LUT dysfunction during the assessment of these patients can help management and possibly facilitate an earlier diagnosis.
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Affiliation(s)
- Ekawat Vichayanrat
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Claire Hentzen
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Amit Batla
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sara Simeoni
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jalesh N Panicker
- Department of Uro‑Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. .,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.
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Chelban V, Vichayanrat E, Schottlaende L, Iodice V, Houlden H. Autonomic dysfunction in genetic forms of synucleinopathies. Mov Disord 2019; 33:359-371. [PMID: 29508456 DOI: 10.1002/mds.27343] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/01/2018] [Accepted: 01/19/2018] [Indexed: 12/31/2022] Open
Abstract
The discovery of genetic links between alpha-synuclein and PD has opened unprecedented opportunities for research into a new group of diseases, now collectively known as synucleinopathies. Autonomic dysfunction, including cardiac sympathetic denervation, has been reported in familial forms of synucleinopathies that have Lewy bodies at the core of their pathogenesis. SNCA mutations and multiplications, LRRK2 disease with Lewy bodies as well as other common, sporadic forms of idiopathic PD, MSA, pure autonomic failure, and dementia with Lewy bodies have all been associated with dysautonomia. By contrast, in familial cases of parkinsonism without Lewy bodies, such as in PARK2, the autonomic profile remains normal throughout the course of the disease. The degeneration of the central and peripheral autonomic systems in genetic as well as sporadic forms of neurodegenerative synucleinopathies correlates with the accumulation of alpha-synuclein immunoreactive-containing inclusions. Given that dysautonomia has a significant impact on the quality of life of sufferers and autonomic symptoms are generally treatable, a prompt diagnostic testing and treatment should be provided. Moreover, new evidence suggests that autonomic dysfunction can be used as an outcome prediction factor in some forms of synucleinopathies or premotor diagnostic markers that could be used in the future to define further research avenues. In this review, we describe the autonomic dysfunction of genetic synucleinopathies in comparison to the dysautonomia of sporadic forms of alpha-synuclein accumulation and provide the reader with an up-to-date overview of the current understanding in this fast-growing field. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Viorica Chelban
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom, and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Ekawat Vichayanrat
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, UCL NHS Trust, London, United Kingdom
| | - Lucia Schottlaende
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom, and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, UCL NHS Trust, London, United Kingdom.,Institute of Neurology, University College London, London, United Kingdom
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom, and National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Ferreira JJ, Trenkwalder C, Mestre TA. Placebo and nocebo responses in other movement disorders besides Parkinson's disease: How much do we know? Mov Disord 2018; 33:1228-1235. [DOI: 10.1002/mds.113] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/20/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Joaquim J. Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa; Instituto de Medicina Molecular; Lisboa Portugal
| | - Claudia Trenkwalder
- Paracelsus-Elena Klinik, Center of Parkinsonism and Movement Disorders, Kassel; Department of Neurosurgery; University Medical Center; Göttingen Germany
| | - Tiago A. Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
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Freeman R, Abuzinadah AR, Gibbons C, Jones P, Miglis MG, Sinn DI. Orthostatic Hypotension. J Am Coll Cardiol 2018; 72:1294-309. [DOI: 10.1016/j.jacc.2018.05.079] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023]
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Bower PG. Multiple system atrophy: Building a global community – 30 years of advocacy efforts. Auton Neurosci 2018; 211:39-42. [DOI: 10.1016/j.autneu.2017.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
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Engen PA, Dodiya HB, Naqib A, Forsyth CB, Green SJ, Voigt RM, Kordower JH, Mutlu EA, Shannon KM, Keshavarzian A. The Potential Role of Gut-Derived Inflammation in Multiple System Atrophy. J Parkinsons Dis 2018; 7:331-346. [PMID: 28234259 DOI: 10.3233/jpd-160991] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent evidence suggests that Parkinson's disease (PD) is associated with intestinal microbiota dysbiosis, abnormal intestinal permeability, and intestinal inflammation. OBJECTIVE Our study aimed to determine if these gut abnormalities are present in another synucleinopathy, multiple system atrophy (MSA). METHODS In six MSA and 11 healthy control subjects, we performed immunohistochemistry studies of colonic sigmoid mucosa to evaluate the intestinal barrier marker Zonula Occludens-1 and the endotoxin-related inflammation marker Toll-like-receptor-4 expression. We also assessed colonic sigmoid mucosal and fecal microbiota compositions using high-throughput 16S ribosomal RNA gene amplicon sequencing. RESULTS MSA subjects showed disrupted tight junction protein Zonula Occludens-1 structure in sigmoid mucosa tissue suggesting intestinal barrier dysfunction. The lipopolysaccharide specific inflammatory receptor Toll-like-receptor-4 was significantly higher in the colonic sigmoid mucosa in MSA relative to healthy controls. Microbiota analysis suggested high relative abundance of gram-negative, putative "pro-inflammatory" bacteria in various family and genus level taxa, from the phylum Bacteroidetes and Proteobacteria, in MSA feces and mucosa. At the taxonomic level of genus, putative "anti-inflammatory" butyrate-producing bacteria were less abundant in MSA feces. Predictive functional analysis indicated that the relative abundance of a number of genes involved in metabolism were lower in MSA feces, whereas the relative abundance of genes involved in lipopolysaccharide biosynthesis were higher in both MSA feces and mucosa compared to healthy controls. CONCLUSIONS This proof-of-concept study provides preliminary evidence that like PD, MSA subjects display evidence of disrupted intestinal barrier integrity, increased marker of endotoxin-related intestinal inflammation, and pro-inflammatory colonic microbiota.
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Affiliation(s)
- Phillip A Engen
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Hemraj B Dodiya
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA.,Department of Pharmacology, Rush University Medical Center, Chicago, IL, USA
| | - Ankur Naqib
- DNA Services Facility, Research Resources Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher B Forsyth
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA.,Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - Stefan J Green
- DNA Services Facility, Research Resources Center, University of Illinois at Chicago, Chicago, IL, USA.,Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Robin M Voigt
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Jeffrey H Kordower
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Ece A Mutlu
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Kathleen M Shannon
- Department of Neurology, University of Wisconsin School of Public Health, Madison, WI, USA
| | - Ali Keshavarzian
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA.,Department of Pharmacology, Rush University Medical Center, Chicago, IL, USA.,Department of Physiology, Rush University Medical Center, Chicago, IL, USA.,Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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14
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Overk C, Rockenstein E, Valera E, Stefanova N, Wenning G, Masliah E. Multiple system atrophy: experimental models and reality. Acta Neuropathol 2018; 135:33-47. [PMID: 29058121 DOI: 10.1007/s00401-017-1772-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 01/08/2023]
Abstract
Multiple system atrophy (MSA) is a rapidly progressing fatal synucleinopathy of the aging population characterized by parkinsonism, dysautonomia, and in some cases ataxia. Unlike other synucleinopathies, in this disorder the synaptic protein, α-synuclein (α-syn), predominantly accumulates in oligodendroglial cells (and to some extent in neurons), leading to maturation defects of oligodendrocytes, demyelination, and neurodegeneration. The mechanisms through which α-syn deposits occur in oligodendrocytes and neurons in MSA are not completely clear. While some studies suggest that α-syn might transfer from neurons to glial cells, others propose that α-syn might be aberrantly overexpressed by oligodendroglial cells. A number of in vivo models have been developed, including transgenic mice overexpressing α-syn under oligodendroglial promoters (e.g.: MBP, PLP, and CNP). Other models have been recently developed either by injecting synthetic α-syn fibrils or brain homogenates from patients with MSA into wild-type mice or by using viral vectors expressing α-syn under the MBP promoter in rats and non-human primates. Each of these models reproduces some of the neuropathological and functional aspects of MSA; however, none of them fully replicate the spectrum of MSA. Understanding better the mechanisms of how α-syn accumulates in oligodendrocytes and neurons will help in developing better models that recapitulate various pathogenic aspects of MSA in combination with translatable biomarkers of early stages of the disease that are necessary to devise disease-modifying therapeutics for MSA.
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15
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Cronin T, Arshad Q, Seemungal BM. Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation. Front Neurol 2017; 8:538. [PMID: 29123498 PMCID: PMC5662638 DOI: 10.3389/fneur.2017.00538] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022] Open
Abstract
The vestibular system consists of the peripheral vestibular organs in the inner ear and the associated extensive central nervous system projections—from the cerebellum and brainstem to the thalamic relays to cortical projections. This system is important for spatial orientation and balance, both of critical ecological importance, particularly for successful navigation in our environment. Balance disorders and spatial disorientation are common presenting features of neurodegenerative diseases; however, little is known regarding central vestibular processing in these diseases. A ubiquitous aspect of central vestibular processing is its promiscuity given that vestibular signals are commonly found in combination with other sensory signals. This review discusses how impaired central processing of vestibular signals—typically in combination with other sensory and motor systems—may account for the impaired balance and spatial disorientation in common neurodegenerative conditions. Such an understanding may provide for new diagnostic tests, potentially useful in detecting early disease while a mechanistic understanding of imbalance and spatial disorientation in these patients may enable a vestibular-targeted therapy for such problems in neurodegenerative diseases. Studies with state of the art central vestibular testing are now much needed to tackle this important topic.
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Affiliation(s)
- Thomas Cronin
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Qadeer Arshad
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Barry M Seemungal
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital, London, United Kingdom
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16
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Abstract
The objective of this study was to identify key features differentiating multiple system atrophy cerebellar type (MSA-C) from idiopathic late-onset cerebellar ataxia (ILOCA). We reviewed records of patients seen in the Massachusetts General Hospital Ataxia Unit between 1992 and 2013 with consensus criteria diagnoses of MSA-C or ILOCA. Twelve patients had definite MSA-C, 53 had possible/probable MSA-C, and 12 had ILOCA. Autonomic features, specifically urinary urgency, frequency, and incontinence with erectile dysfunction in males, differentiated MSA-C from ILOCA throughout the disease course (p = 0.005). Orthostatic hypotension developed later and differentiated MSA-C from ILOCA (p < 0.01). REM sleep behavior disorder (RBD) occurred early in possible/probable MSA-C (p < 0.01). Late MSA-C included pathologic laughing and crying (PLC, p < 0.01), bradykinesia (p = 0.01), and corticospinal findings (p = 0.01). MRI distinguished MSA-C from ILOCA by atrophy of the brainstem (p < 0.01) and middle cerebellar peduncles (MCP, p = 0.02). MSA-C progressed faster than ILOCA: by 6 years, MSA-C walker dependency was 100 % and ILOCA 33 %. MSA-C survival was 8.4 ± 2.5 years. Mean length of ILOCA illness to date is 15.9 ± 6.4 years. A sporadic onset, insidiously developing cerebellar syndrome in midlife, with autonomic features of otherwise unexplained bladder dysfunction with or without erectile dysfunction in males, and atrophy of the cerebellum, brainstem, and MCP points strongly to MSA-C. RBD and postural hypotension confirm the diagnosis. Extrapyramidal findings, corticospinal tract signs, and PLC are helpful but not necessary for diagnosis. Clarity in early MSA-C diagnosis can prevent unnecessary investigations and facilitate therapeutic trials.
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17
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Gerstenecker A. The Neuropsychology (Broadly Conceived) of Multiple System Atrophy, Progressive Supranuclear Palsy, and Corticobasal Degeneration. Arch Clin Neuropsychol 2017; 32:861-875. [DOI: 10.1093/arclin/acx093] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 11/14/2022] Open
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18
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Abstract
Parkinson's disease (PD), dementia with Lewy Bodies (DLB), and multiple system atrophy (MSA) are three major synucleinopathies characterized by α-synuclein-containing inclusions in the brains of patients. Because the cell types and brain structures that are affected vary markedly between the disorders, the patients have different clinical manifestations in addition to some overlapping symptoms, which are the basis for differential diagnosis. Cognitive impairment and depression associated with hippocampal dysfunction are frequently observed in these disorders. While various α-synuclein-containing inclusions are found in the hippocampal formation, increasing evidence supports that small α-synuclein aggregates or oligomers may be the real culprit, causing deficits in neurotransmission and neurogenesis in the hippocampus and related brain regions, which constitute the major mechanism for the hippocampal dysfunctions and associated neuropsychiatric manifestations in synucleinopathies.
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Affiliation(s)
- Weiwei Yang
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Shun Yu
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China.
- Beijing Key Laboratory for Parkinson's Disease, Beijing, China.
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19
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Matsushima M, Yabe I, Oba K, Sakushima K, Mito Y, Takei A, Houzen H, Tsuzaka K, Yoshida K, Maruo Y, Sasaki H. Comparison of Different Symptom Assessment Scales for Multiple System Atrophy. Cerebellum 2016; 15:190-200. [PMID: 26093615 DOI: 10.1007/s12311-015-0686-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To identify the most sensitive scale for use in clinical trials on multiple system atrophy (MSA), a short and sensitive scale is needed for MSA clinical trials. Potential candidates are the Unified MSA Rating Scale (UMSARS), Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), MSA Health-Related Quality of Life scale (MSA-QoL), and Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire (SCOPA-AUT). We enrolled patients with MSA from eight hospitals in Hokkaido, Japan. Board-certified neurologists assessed each patient at 6-month intervals and scored them on the UMSARS, SARA, BBS, MSA-QoL, and SCOPA-AUT. Score changes were evaluated using the standardized response mean (SRM). The correlation between disease duration and each score was examined. The first evaluation was conducted on 85 patients (60 patients with MSA cerebellar ataxia dominant subtype [MSA-C] and 25 patients with MSA Parkinsonism-dominant subtype [MSA-P]). Sixty-nine patients were examined after 6 months and 63 patients after 12 months. The UMSARS Part 4 had the largest SRM after 6 months and the SARA after 12 months. SRMs for MSA-P, the shorter duration group, and the early-onset group were larger than were those for MSA-C, the longer duration group, and the late-onset group. SRMs for items regarding skilled hand activities, walking, and standing were relatively large. Our study indicates that the UMSARS (parts 2 and 4), SARA, and BBS are sensitive scales for evaluating MSA progression over 12 months. Items with large SRMs effectively evaluated short-term changes.
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Affiliation(s)
- Masaaki Matsushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Koji Oba
- Research and Clinical Trial Center, Hokkaido University Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Biostatistics, School of Public Health, Graduate School of Medicine, and Interfaculty Initiative in Information Studies, The University of Tokyo, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Ken Sakushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yasunori Mito
- Sapporo City General Hospital, 1-1 Kita-11, Nishi-13, Chuo-ku, Sapporo, 060-8604, Japan
| | - Asako Takei
- Hokuyukai Neurological Hospital, Niju-Yon-Ken 2-2-4-30, Nishi-ku, Sapporo, 063-0802, Japan
| | - Hideki Houzen
- Obihiro Kosei Hospital, Nishi-6, Minami-8, Obihiro, 080-0016, Japan
| | - Kazufumi Tsuzaka
- Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro, 085-8533, Japan
| | - Kazuto Yoshida
- Japanese Red Cross Asahikawa Hospital, 1-1 Akebono, Asahikawa, 070-8530, Japan
| | - Yasunori Maruo
- Hakodate Municipal Hospital, 1-10-1 Minato-cho, Hakodate, 041-8680, Japan
| | - Hidenao Sasaki
- Department of Neurology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
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20
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Ogaki K, Koga S, Aoki N, Lin W, Suzuki K, Ross OA, Dickson DW. Adult-onset cerebello-brainstem dominant form of X-linked adrenoleukodystrophy presenting as multiple system atrophy: case report and literature review. Neuropathology 2015; 36:64-76. [PMID: 26227820 DOI: 10.1111/neup.12230] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/13/2015] [Indexed: 11/26/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is the most common peroxisomal disorder and is caused by ABCD1 mutations. A cerebello-brainstem dominant form that mainly involves the cerebellum and brainstem is summarized in a review of the literature, with autopsy-confirmed cases exceedingly rare. We report a 69-year-old White man who was diagnosed with this rare disorder and describe neuropathologic, ultrastructural and genetic analyses. He did not have adrenal insufficiency or a family history of X-ALD or Addison's disease. His initial symptom was temporary loss of eyesight at age 34 years. His major symptoms were chronic and progressive gait disorder, weakness in his lower extremities and spasticity, as well as autonomic failure and cerebellar ataxia suggesting possible multiple system atrophy (MSA). He also had seizures, hearing loss and sensory disturbances. His brain MRI showed no obvious atrophy or significant white matter pathology in cerebrum, brainstem or cerebellum. He died at age 69 years with a diagnosis of MSA. Microscopic analysis showed mild, patchy myelin rarefaction with perivascular clusters of PAS-positive, CD68-positive macrophages in the white matter most prominent in the cerebellum and occipital lobe, but also affecting the optic tract and internal capsule. Electron microscopy of cerebellar white matter showed cleft-like trilamellar cytoplasmic inclusions in macrophages typical of X-ALD, which prompted genetic analysis that revealed a novel ABCD1 mutation, p.R163G. Given the relatively mild pathological findings and long disease duration, it is likely that the observed pathology was the result of a slow and indolent disease process. We described a patient who had sporadic cerebello-brainstem dominant form of X-ALD with long clinical course, mild pathological findings, and an ABCD1 p.R163G substitution. We also review a total of 34 cases of adult-onset cerebello-brainstem dominant form of X-ALD. Although rare, X-ALD should be considered in the differential diagnosis of MSA.
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Affiliation(s)
- Kotaro Ogaki
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Naoya Aoki
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Wenlang Lin
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Kinuko Suzuki
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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21
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Chen D, Wei X, Zou J, Wang R, Liu X, Xu X, Lu J, Wang Z, Tang B, Wang B, Jin K, Wang Q. Contra-Directional Expression of Serum Homocysteine and Uric Acid as Important Biomarkers of Multiple System Atrophy Severity: A Cross-Sectional Study. Front Cell Neurosci 2015. [PMID: 26217177 PMCID: PMC4492156 DOI: 10.3389/fncel.2015.00247] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HIGHLIGHTS Serum Hcy was higher in MSA patients when compared to healthy subjects, particularly in male patients.Serum UA was lower in MSA patients when compared healthy subjects, particularly in male patients.Serum Hcy levels were significantly positively correlated with the severity of MSA.The ROC curve for the combination of Hcy and UA showed potential diagnostic value in discriminating MSA from healthy subjects. AIM There is evidence suggesting that inflammatory responses play a critical role in the pathogenesis of multiple system atrophy (MSA). Whether inflammatory mediators can be used as reliable biomarkers to detect the severity and progression of MSA remains largely unknown. METHODS We performed a cross-sectional study that included 47 patients with MSA and 50 healthy age-matched controls. Serum levels of homocysteine (Hcy), uric acid (UA), and C-reactive protein (CRP) were measured. These levels positively correlated with the severity of MSA, based on both motor and non-motor symptoms. Several scales were used to rate the severity of MSA, including the Unified multiple system atrophy rating scale, Parkinson's disease sleep scale, Non-motor Symptoms Scale, the Schwab & England activities of daily living scale, Webster Scale, modified Hoehn and Yahr staging scale, and the Mini-Mental State Examination. Receiver operating characteristic (ROC) curves was applied to map the diagnostic accuracy of MSA against healthy subjects. RESULTS Compared with healthy subjects, we found that serum Hcy was higher, UA was lower, and CRP levels were unchanged in MSA patients. These findings were especially prominent in male patients. No significant differences of serum Hcy and UA were observed between patients of MSA and PD. Interestingly, there was a significant correlation between Hcy levels and MSA severity such as movement dysfunction, declined cognition, and cardiovascular symptoms. Additionally, the ROC curve for the combination of Hcy and UA (AUC 0.736) showed potential diagnostic value in discriminating MSA from healthy subjects. CONCLUSION Our findings suggest that the inflammatory mediators Hcy and UA may play important roles in the pathogenesis of MSA. The measurement of serum Hcy and UA levels could then be a useful tool to accurately distinguish MSA from healthy subjects.
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Affiliation(s)
- Dan Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Xiaobo Wei
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Jing Zou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Rui Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Xu Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Xiaofeng Xu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Jianjun Lu
- Department of Neurology, Guangdong 999 Brain Hospital , Guangzhou , China
| | - Zhanhang Wang
- Department of Neurology, Guangdong 999 Brain Hospital , Guangzhou , China
| | - Beisha Tang
- The State Key Laboratory of Medical Genetics, Central South University , Changsha , China
| | - Brian Wang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center , Fort Worth, TX , USA
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center , Fort Worth, TX , USA
| | - Qing Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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22
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Wen XD, Li HF, Wang HX, Ni W, Dong Y, Wu ZY. Mutation Analysis of COQ2 in Chinese Patients with Cerebellar Subtype of Multiple System Atrophy. CNS Neurosci Ther 2015; 21:626-30. [PMID: 26096180 DOI: 10.1111/cns.12412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/30/2022] Open
Abstract
AIMS Recently, mutations in COQ2 encoding para-hydroxybenzoate-polyprenyl transferase have been identified to increase the risk of multiple system atrophy (MSA) in multiplex families and sporadic cases. The prevalence of COQ2 mutations was showed to be higher in cerebellar subtype (MSA-C) than parkinsonism subtype (MSA-P). The aim of this study was to investigate the association between COQ2 mutations and MSA-C in Chinese patients. METHODS A Chinese cohort of 116 patients with MSA-C and 192 healthy control individuals were recruited. Sanger sequencing of COQ2 was performed in all these subjects. RESULTS Two missense mutations (p.L402F and p.R173H) and one synonymous mutation (p.A32A) were detected in 3 patients, respectively. They were not found in the 192 controls as well as the 1000 Genomes Database. The p.L402F and p.A32A were novel. CONCLUSION Our results indicated that COQ2 tended to play a population-specific and subtype-depended role in conferring susceptibility to MSA.
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Affiliation(s)
- Xiao-Dan Wen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong-Fu Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Xia Wang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wang Ni
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi-Ying Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China
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23
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Low PA, Reich SG, Jankovic J, Shults CW, Stern MB, Novak P, Tanner CM, Gilman S, Marshall FJ, Wooten F, Racette B, Chelimsky T, Singer W, Sletten DM, Sandroni P, Mandrekar J. Natural history of multiple system atrophy in the USA: a prospective cohort study. Lancet Neurol 2015; 14:710-9. [PMID: 26025783 PMCID: PMC4472464 DOI: 10.1016/s1474-4422(15)00058-7] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/10/2015] [Accepted: 04/24/2015] [Indexed: 12/20/2022]
Abstract
Background Multiple system atrophy (MSA) is a rare, fatal neurodegenerative disorder exhibiting a combination of parkinsonism and/or cerebellar ataxia with autonomic failure. We report the first North American prospective natural history study of MSA, and the effects of phenotype and autonomic failure on prognosis. Methods 175 subjects with probable MSA, both MSA-P and MSA-C, were recruited and prospectively followed for 5 years with evaluations every 6 months in 12 centers. Natural history was evaluated by Kaplan-Meier survival analysis. We compared MSA-P with MSA-C and evaluated predictors of outcome. These subjects were evaluated with UMSARS I (a functional score of symptoms and ability to undertake activities of daily living), UMSARS II (neurological motor evaluation), and the Composite Autonomic Symptoms Scale (COMPASS)-select (a measure of autonomic symptoms and autonomic functional status. Findings Mean age of symptom onset was 63.4 (SD 8.57) years. Median survival from symptom onset by Kaplan-Meier analysis was 9.8 years (95% CI 8.8-10.7). Subjects with severe symptomatic autonomic failure (symptomatic orthostatic hypotension, urinary incontinence) at diagnosis had a worse prognosis, surviving 8.0 years (95% CI, 6.5-9.5, n=62) while remaining subjects survived a median of 10.3 years (95% CI, 9.3-11.4, n=113). At baseline MSA-P (n=126) and MSA-C (n=49) were not different in symptoms and function, UMSARS I, 25.2 (8.08) vs 24.6 (8.34), p=0.835; UMSARS II, 26.4 (8.77) vs 25.4 (10.51), p=0.7635; COMPASS_select), 43.5 (18.66) vs 42.8 (19.56), p=0.835. Progression, evaluated by change in UMSARS I, UMSARS II, COMPASS_select over the next 5 years, was not significantly different between MSA-P and MSA-C. Median time to death from enrollment baseline was 1.8 (95% CI, 0.9-2.7) years. Interpretation Probable MSA represents late-stage disease with short survival. Natural history of MSA-P and MSA-C are similar. Severe symptomatic autonomic failure at diagnosis is associated with worse prognosis. Funding National Institutes of Health (P01 NS044233), Mayo CTSA (UL1 TR000135), the Kathy Shih Memorial Foundation, and Mayo funds.
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Affiliation(s)
- Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Clifford W Shults
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Matthew B Stern
- Parkinson's Disease and Movement Disorders Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Peter Novak
- Department of Neurology, University of Massachusetts, Worcester, MA, USA
| | - Caroline M Tanner
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Sid Gilman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Frederick Wooten
- Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - Brad Racette
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Thomas Chelimsky
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Jay Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Sakushima K, Nishimoto N, Nojima M, Matsushima M, Yabe I, Sato N, Mori M, Sasaki H. Epidemiology of Multiple System Atrophy in Hokkaido, the Northernmost Island of Japan. Cerebellum 2015; 14:682-7. [DOI: 10.1007/s12311-015-0668-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Deguchi K, Ikeda K, Kume K, Takata T, Kokudo Y, Kamada M, Touge T, Honjo N, Masaki T. Significance of the hot-cross bun sign on T2*-weighted MRI for the diagnosis of multiple system atrophy. J Neurol 2015; 262:1433-9. [PMID: 25845765 DOI: 10.1007/s00415-015-7728-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 12/27/2022]
Abstract
Although the sensitive detection of putaminal iron deposition by T2*-weighted imaging (T2*-WI) is of diagnostic value for multiple system atrophy (MSA), the diagnostic significance of the pontine hot-cross bun (HCB) sign with increased ferritin-bound iron in the background remains unknown. We retrospectively evaluated the cases of 33 patients with cerebellar-form MSA (MSA-C) and 21 with MSA of the parkinsonian form (MSA-P) who underwent an MRI study with a 1.5-T system. Visualization of the HCB sign, posterior putaminal hypointensity and putaminal hyperintense rim on T2*-WI was assessed by two neurologists independently using an established visual grade, and were compared with those on T2-weighted imaging (T2-WI). The visual grade of pontine and putaminal signal changes was separately assessed for probable MSA (advanced stage) and possible MSA (early stage). T2*-WI demonstrated significantly higher grades of HCB sign than T2-WI (probable MSA-C, n = 27, p < 0.001; possible MSA-C, n = 6, p < 0.05; probable MSA-P, n = 13, p < 0.01). The visual grade of the HCB sign on T2*-WI in the possible MSA-C patients was comparable to that in the probable MSA-C patients. Although the HCB sign in MSA-P was of lower visual grade than in MSA-C even on T2*-WI, some patients showed evolution of the HCB sign preceding the appearance of the putaminal changes. These findings suggest that T2*-WI is of extreme value for detecting the HCB sign, which is often cited as a hallmark of MSA. The appearance of the HCB sign on T2*-WI might not only support but also improve the diagnosis of MSA.
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Affiliation(s)
- Kazushi Deguchi
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan,
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Perez-Lloret S, Flabeau O, Fernagut PO, Pavy-Le Traon A, Rey MV, Foubert-Samier A, Tison F, Rascol O, Meissner WG. Current Concepts in the Treatment of Multiple System Atrophy. Mov Disord Clin Pract 2015; 2:6-16. [PMID: 30363880 DOI: 10.1002/mdc3.12145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 12/21/2022] Open
Abstract
MSA is a progressive neurodegenerative disorder characterized by autonomic failure and a variable combination of poor levodopa-responsive parkinsonism and cerebellar ataxia (CA). Current therapeutic management is based on symptomatic treatment. Almost one third of MSA patients may benefit from l-dopa for the symptomatic treatment of parkinsonism, whereas physiotherapy remains the best therapeutic option for CA. Only midodrine and droxidopa were found to be efficient for neurogenic hypotension in double-blind, controlled studies, whereas other symptoms of autonomic failure may be managed with off-label treatments. To date, no curative treatment is available for MSA. Recent results of neuroprotective and -restorative trials have provided some hope for future advances. Considerations for future clinical trials are also discussed in this review.
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Affiliation(s)
- Santiago Perez-Lloret
- Laboratory of Epidemiology and Experimental Pharmacology Institute for Biomedical Research (BIOMED) School of Medical Sciences Pontifical Catholic University of Argentina (UCA) Buenos Aires Argentina.,The National Scientific and Technical Research Council (CONICET) Buenos Aires Argentina
| | - Olivier Flabeau
- Department of Neurology Center Hospitalier de la Côte Basque Bayonne France
| | - Pierre-Olivier Fernagut
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France
| | - Anne Pavy-Le Traon
- Departments of Clinical Pharmacology and Neurosciences University Hospital and University of Toulouse 3 Toulouse France.,French Reference Center for MSA Toulouse University Hospital Toulouse France
| | - María Verónica Rey
- Laboratory of Epidemiology and Experimental Pharmacology Institute for Biomedical Research (BIOMED) School of Medical Sciences Pontifical Catholic University of Argentina (UCA) Buenos Aires Argentina.,The National Scientific and Technical Research Council (CONICET) Buenos Aires Argentina
| | - Alexandra Foubert-Samier
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France.,French Reference Center for MSA Bordeaux University Hospital Bordeaux France
| | - Francois Tison
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France.,French Reference Center for MSA Bordeaux University Hospital Bordeaux France
| | - Olivier Rascol
- Departments of Clinical Pharmacology and Neurosciences University Hospital and University of Toulouse 3 Toulouse France.,French Reference Center for MSA Toulouse University Hospital Toulouse France
| | - Wassilios G Meissner
- Institut des Maladies Neurodégénératives Université de Bordeaux Bordeaux France.,CNRS Institut des Maladies Neurodégénératives Bordeaux France.,French Reference Center for MSA Bordeaux University Hospital Bordeaux France
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Ciolli L, Krismer F, Nicoletti F, Wenning GK. An update on the cerebellar subtype of multiple system atrophy. Cerebellum Ataxias 2014; 1:14. [PMID: 26331038 PMCID: PMC4552412 DOI: 10.1186/s40673-014-0014-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 01/05/2023]
Abstract
Multiple system atrophy is a rare and fatal neurodegenerative disorder characterized by progressive autonomic failure, ataxia and parkinsonism in any combination. The clinical manifestations reflect central autonomic and striatonigral degeneration as well as olivopontocerebellar atrophy. Glial cytoplasmic inclusions, composed of α-synuclein and other proteins are considered the cellular hallmark lesion. The cerebellar variant of MSA (MSA-C) denotes a distinctive motor subtype characterized by progressive adult onset sporadic gait ataxia, scanning dysarthria, limb ataxia and cerebellar oculomotor dysfunction. In addition, there is autonomic failure and variable degrees of parkinsonism. A range of other disorders may present with MSA-C like features and therefore the differential diagnosis of MSA-C is not always straightforward. Here we review key aspects of MSA-C including pathology, pathogenesis, diagnosis, clinical features and treatment, paying special attention to differential diagnosis in late onset sporadic cerebellar ataxias.
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Affiliation(s)
- Ludovico Ciolli
- Sapienza University, Via di Grottarossa, 1035-00189 Rome, Italy ; Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ferdinando Nicoletti
- IRCSS NEUROMED, Pozzilli, Isernia Italy ; Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University, School of Medicine and Psychology, Rome, Italy
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Abstract
Sporadic neurodegenerative diseases are complex in nature, that is, they involve multiple genetic and environmental factors that may play roles at the molecular level. In contrast to diseases with Mendelian inheritance, the genomic signatures of common sporadic forms of neurodegenerative diseases largely remain unknown. Over the past decade, genome-wide association studies employing common single-nucleotide polymorphisms have been intensively conducted, in which the theoretical framework is based on the "common disease-common variants" hypothesis. Another paradigm is a sequence-based association study under the "common disease-multiple rare variants" hypothesis. Because current next-generation sequencing technologies enable us to obtain virtually all the variants in human genome irrespective of allele frequencies, it is anticipated that sequence-based association studies will become the mainstream approach. In this review, we present brief overviews of molecular genetic approaches to elucidate the molecular bases of sporadic forms of neurodegenerative diseases, including Alzheimer disease, Parkinson disease, and multiple system atrophy as examples.
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Affiliation(s)
- Jun Mitsui
- Department of Neurology, The University of Tokyo, Graduate School of Medicine, Japan
| | - Shoji Tsuji
- Department of Neurology, The University of Tokyo, Graduate School of Medicine, Japan.
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Lin DJ, Hermann KL, Schmahmann JD. Multiple system atrophy of the cerebellar type: clinical state of the art. Mov Disord 2014; 29:294-304. [PMID: 24615754 DOI: 10.1002/mds.25847] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/27/2013] [Accepted: 01/27/2014] [Indexed: 01/21/2023] Open
Abstract
Multiple system atrophy (MSA) is a late-onset, sporadic neurodegenerative disorder clinically characterized by autonomic failure and either poorly levodopa-responsive parkinsonism or cerebellar ataxia. It is neuropathologically defined by widespread and abundant central nervous system α-synuclein-positive glial cytoplasmic inclusions and striatonigral and/or olivopontocerebellar neurodegeneration. There are two clinical subtypes of MSA distinguished by the predominant motor features: the parkinsonian variant (MSA-P) and the cerebellar variant (MSA-C). Despite recent progress in understanding the pathobiology of MSA, investigations into the symptomatology and natural history of the cerebellar variant of the disease have been limited. MSA-C presents a unique challenge to both clinicians and researchers alike. A key question is how to distinguish early in the disease course between MSA-C and other causes of adult-onset cerebellar ataxia. This is a particularly difficult question, because the clinical framework for conceptualizing and studying sporadic adult-onset ataxias continues to undergo flux. To date, several investigations have attempted to identify clinical features, imaging, and other biomarkers that may be predictive of MSA-C. This review presents a clinically oriented overview of our current understanding of MSA-C with a focus on evidence for distinguishing MSA-C from other sporadic, adult-onset ataxias.
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Affiliation(s)
- David J Lin
- Ataxia Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
BACKGROUND Multiple-system atrophy is an intractable neurodegenerative disease characterized by autonomic failure in addition to various combinations of parkinsonism, cerebellar ataxia, and pyramidal dysfunction. Although multiple-system atrophy is widely considered to be a nongenetic disorder, we previously identified multiplex families with this disease, which indicates the involvement of genetic components. METHODS In combination with linkage analysis, we performed whole-genome sequencing of a sample obtained from a member of a multiplex family in whom multiple-system atrophy had been diagnosed on autopsy. We also performed mutational analysis of samples from members of five other multiplex families and from a Japanese series (363 patients and two sets of controls, one of 520 persons and one of 2383 persons), a European series (223 patients and 315 controls), and a North American series (172 patients and 294 controls). On the basis of these analyses, we used a yeast complementation assay and measured enzyme activity of parahydroxybenzoate-polyprenyl transferase. This enzyme is encoded by the gene COQ2 and is essential for the biosynthesis of coenzyme Q10. Levels of coenzyme Q10 in lymphoblastoid cells and brain tissue were measured on high-performance liquid chromatography. RESULTS We identified a homozygous mutation (M78V-V343A/M78V-V343A) and compound heterozygous mutations (R337X/V343A) in COQ2 in two multiplex families. Furthermore, we found that a common variant (V343A) and multiple rare variants in COQ2, all of which are functionally impaired, are associated with sporadic multiple-system atrophy. The V343A variant was exclusively observed in the Japanese population. CONCLUSIONS Functionally impaired variants of COQ2 were associated with an increased risk of multiple-system atrophy in multiplex families and patients with sporadic disease, providing evidence of a role of impaired COQ2 activities in the pathogenesis of this disease. (Funded by the Japan Society for the Promotion of Science and others.).
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Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, Köllensperger M, Goebel G, Pfeiffer KP, Barone P, Pellecchia MT, Quinn NP, Koukouni V, Fowler CJ, Schrag A, Mathias CJ, Giladi N, Gurevich T, Dupont E, Ostergaard K, Nilsson CF, Widner H, Oertel W, Eggert KM, Albanese A, del Sorbo F, Tolosa E, Cardozo A, Deuschl G, Hellriegel H, Klockgether T, Dodel R, Sampaio C, Coelho M, Djaldetti R, Melamed E, Gasser T, Kamm C, Meco G, Colosimo C, Rascol O, Meissner WG, Tison F, Poewe W. The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 2013; 12:264-74. [PMID: 23391524 PMCID: PMC3581815 DOI: 10.1016/s1474-4422(12)70327-7] [Citation(s) in RCA: 343] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. METHODS Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. FINDINGS 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size estimation showed that an interventional trial with 258 patients (129 per group) would be able to detect a 30% effect size in 1-year UMSARS motor examination decline rates at 80% power. INTERPRETATION Our prospective dataset provides new insights into the evolution of MSA based on a follow-up period that exceeds that of previous studies. It also represents a useful resource for patient counselling and planning of multicentre trials.
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Affiliation(s)
- Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Abstract
Introduction Multiple system atrophy is a late, adult-onset α-synucleinopathy with no data on the effect of pregnancy on the disease course. Early stage multiple system atrophy can be difficult to distinguish from Parkinson's disease. Case presentation We describe the case of an Irish woman with parkinsonism starting at age 31, initially diagnosed as having dopa-responsive, idiopathic Parkinson's disease, who successfully delivered a full-term child at age 35. Her pregnancy was complicated by severe orthostatic hypotension and motor fluctuations. Two years post-partum, she underwent bilateral subthalamic nuclei deep brain stimulation for intractable motor fluctuations and disabling dyskinesia. After this treatment course she experienced deterioration of motor symptoms and death eight years after disease onset. Post-mortem neuropathological examination revealed striatonigral degeneration and α-synuclein-positive glial cytoplasmic inclusions in brain stem nuclei, basal ganglia and white matter tracts, consistent with a neuropathological diagnosis of multiple system atrophy. Conclusions Multiple system atrophy can affect women of child-bearing age and pregnancy may be associated with marked disease progression.
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Affiliation(s)
- Lirong Zhu
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.
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Abstract
Multiple system atrophy (MSA) is characterized by a variable combination of
cerebellar ataxia, parkinsonism and pyramidal signs associated with autonomic
failure. Classically, cognitive impairment was not considered a clinical feature
of MSA and dementia was pointed out as an exclusion diagnostic criteria. Based
on comprehensive neuropsychological assessment, cognitive impairment was found
to be a frequent feature in MSA, and clinically-defined dementia is now reported
in 14-16% of cases. This article reviews the current data on cognitive
impairment in MSA along with its neuropsychological profile and
pathophysiology.
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Affiliation(s)
- Agessandro Abrahão
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Livia Almeida Dutra
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Pedro Braga Neto
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - José Luiz Pedroso
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Ricardo Araújo de Oliveira
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Orlando Graziani Povoas Barsottini
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
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Geser F, Malunda JA, Hurtig HI, Duda JE, Wenning GK, Gilman S, Low PA, Lee VMY, Trojanowski JQ. TDP-43 pathology occurs infrequently in multiple system atrophy. Neuropathol Appl Neurobiol 2011; 37:358-65. [PMID: 20942898 DOI: 10.1111/j.1365-2990.2010.01136.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS AND METHODS The α-synucleinopathy multiple system atrophy (MSA) and diseases defined by pathological 43-kDa transactive response DNA-binding protein (TDP-43) or fused in sarcoma (FUS) aggregates such as amyotrophic lateral sclerosis and frontotemporal lobar degeneration show overlapping clinico-pathological features. Consequently, we examined MSA for evidence of TDP-43 or FUS pathology utilizing immunohistochemical studies in autopsy material from 29 MSA patients. RESULTS TDP-43 pathology was generally rare, and there were no FUS lesions. The TDP-43 lesions were located predominantly in medio-temporal lobe and subcortical brain areas and were comprised mainly of dystrophic processes and perivascular (and subpial) lesions. CONCLUSIONS The multisystem clinical symptoms and signs of MSA, and in particular the neurobehavioural/cognitive and pyramidal features, appear not to result from concomitant TDP-43 or FUS pathology, but rather from widespread white matter α-synuclein positive glial cytoplasmic inclusions and neurodegeneration in keeping with a primary α-synuclein-mediated oligodendrogliopathy. The gliodegenerative disease MSA evidently results from different pathogenetic mechanisms than neurodegenerative diseases linked to pathological TDP-43.
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Affiliation(s)
- F Geser
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA
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Saute JAM, Donis KC, Serrano-munuera C, Genis D, Ramirez LT, Mazzetti P, Pérez LV, Latorre P, Sequeiros J, Matilla-dueñas A, Jardim LB; On behalf of the Iberoamerican Multidisciplinary Network for the Study of Movement Disorders (RIBERMOV) Study Group. Ataxia Rating Scales—Psychometric Profiles, Natural History and Their Application in Clinical Trials. Cerebellum 2012; 11:488-504. [DOI: 10.1007/s12311-011-0316-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ubhi K, Low P, Masliah E. Multiple system atrophy: a clinical and neuropathological perspective. Trends Neurosci. 2011;34:581-590. [PMID: 21962754 DOI: 10.1016/j.tins.2011.08.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/16/2011] [Accepted: 08/18/2011] [Indexed: 01/17/2023]
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disease involving motor abnormalities that include akinesia, rigidity and postural instability. While improved diagnostic criteria have aided the accurate diagnosis of MSA, our understanding of the neuropathological aspects underlying MSA was bolstered by the identification of α-synuclein (α-syn) as the primary constituent of the abnormal protein aggregates observed in the brains of MSA patients. The generation of transgenic animal models of MSA coupled with an increasing understanding of the biochemical structure and function of α-syn has highlighted a number of key pathological pathways thought to underlie the neurodegeneration observed in MSA. This review summarizes key findings in the field, discusses current areas of debate, and describes current experimental approaches towards disease-modifying therapies.
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Payan CAM, Viallet F, Landwehrmeyer BG, Bonnet AM, Borg M, Durif F, Lacomblez L, Bloch F, Verny M, Fermanian J, Agid Y, Ludolph AC, Leigh PN, Bensimon G. Disease severity and progression in progressive supranuclear palsy and multiple system atrophy: validation of the NNIPPS--Parkinson Plus Scale. PLoS One 2011; 6:e22293. [PMID: 21829612 PMCID: PMC3150329 DOI: 10.1371/journal.pone.0022293] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/20/2011] [Indexed: 11/18/2022] Open
Abstract
Background The Natural History and Neuroprotection in Parkinson Plus Syndromes (NNIPPS) study was a large phase III randomized placebo-controlled trial of riluzole in Progressive Supranuclear Palsy (PSP, n = 362) and Multiple System Atrophy (MSA, n = 398). To assess disease severity and progression, we constructed and validated a new clinical rating scale as an ancillary study. Methods and Findings Patients were assessed at entry and 6-montly for up to 3 years. Evaluation of the scale's psychometric properties included reliability (n = 116), validity (n = 760), and responsiveness (n = 642). Among the 85 items of the initial scale, factor analysis revealed 83 items contributing to 15 clinically relevant dimensions, including Activity of daily Living/Mobility, Axial bradykinesia, Limb bradykinesia, Rigidity, Oculomotor, Cerebellar, Bulbar/Pseudo-bulbar, Mental, Orthostatic, Urinary, Limb dystonia, Axial dystonia, Pyramidal, Myoclonus and Tremor. All but the Pyramidal dimension demonstrated good internal consistency (Cronbach α≥0.70). Inter-rater reliability was high for the total score (Intra-class coefficient = 0.94) and 9 dimensions (Intra-class coefficient = 0.80–0.93), and moderate (Intra-class coefficient = 0.54–0.77) for 6. Correlations of the total score with other clinical measures of severity were good (rho≥0.70). The total score was significantly and linearly related to survival (p<0.0001). Responsiveness expressed as the Standardized Response Mean was high for the total score slope of change (SRM = 1.10), though higher in PSP (SRM = 1.25) than in MSA (SRM = 1.0), indicating a more rapid progression of PSP. The slope of change was constant with increasing disease severity demonstrating good linearity of the scale throughout disease stages. Although MSA and PSP differed quantitatively on the total score at entry and on rate of progression, the relative contribution of clinical dimensions to overall severity and progression was similar. Conclusions The NNIPPS-PPS has suitable validity, is reliable and sensitive, and therefore is appropriate for use in clinical studies with PSP or MSA. Trial Registration ClinicalTrials.gov NCT00211224
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Affiliation(s)
- Christine A. M. Payan
- Département de Pharmacologie Clinique, Hôpital de la Pitié-Salpêtrière, APHP, UPMC Pharmacologie, Paris 6, UMR 7211, Paris, France
| | - François Viallet
- Service de Neurologie, Centre Hospitalier du pays d'Aix, Aix en Provence, France
| | | | - Anne-Marie Bonnet
- Fédération de Neurologie, INSERM, Centre d'Investigation Clinique CIC9503, Hôpital de la Pitié-Salpêtrière, APHP & UPMC Université Paris 6, Paris, France
| | - Michel Borg
- Service de Neurologie, Hôpital Pasteur, Nice, France
| | - Franck Durif
- Service de Neurologie, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Lucette Lacomblez
- Département de Neurologie, Hôpital de la Pitié-Salpêtrière, APHP, UPMC, Pharmacologie, Paris 6, INSERM, UMR-S 678, Paris, France
| | - Frédéric Bloch
- Fédération de Neurologie, INSERM, Centre d'Investigation Clinique CIC9503, Hôpital de la Pitié-Salpêtrière, APHP & UPMC Université Paris 6, Paris, France
| | - Marc Verny
- Centre de Gériatrie, Groupe Hospitalier Pitié-Salpêtrière & UPMC Université Paris 6, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jacques Fermanian
- Service de Biostatistiques, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Yves Agid
- Fédération de Neurologie, INSERM, Centre d'Investigation Clinique CIC9503, Hôpital de la Pitié-Salpêtrière, APHP & UPMC Université Paris 6, Paris, France
| | | | - Peter N. Leigh
- Clinical Neurosciences, Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Falmer, United Kingdom
- * E-mail: (GB); (PNL)
| | - Gilbert Bensimon
- Département de Pharmacologie Clinique, Hôpital de la Pitié-Salpêtrière, APHP, UPMC Pharmacologie, Paris 6, UMR 7211, Paris, France
- * E-mail: (GB); (PNL)
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You H, Wang J, Wang H, Zang YF, Zheng FL, Meng CL, Feng F. Altered regional homogeneity in motor cortices in patients with multiple system atrophy. Neurosci Lett 2011; 502:18-23. [PMID: 21798310 DOI: 10.1016/j.neulet.2011.07.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 06/14/2011] [Accepted: 07/11/2011] [Indexed: 11/18/2022]
Abstract
Typical histopathological findings of multiple system atrophy (MSA) have been observed in motor related cortices, in addition to the common areas of the striatum, substantia nigra, olivopontocerebellar pathways, the intermediolateral cell columns of the spinal cord, and the cerebellum. The purpose of this study is to test the hypothesis that functional impairment associated with the histopathological findings exists in the motor cortex of MSA patients using resting-state fMRI. Twenty clinically probable MSA patients (9 with MSA-P and 11 with MSA-C subtype) and 11 healthy controls (HCs) were studied. The regional homogeneity (ReHo) approach was used to analyze low frequency spontaneous fluctuation of blood oxygen level dependent signal. Compared with the HCs, the MSA patients showed significantly decreased ReHo in the left primary sensorimotor cortex, posterior cingulate cortex, left lateral prefrontal cortex (PFC) and right inferior parietal lobule (IPL), together with increased ReHo in the right primary sensorimotor cortex, bilateral premotor cortices, bilateral supplementary motor areas, medial PFC and left IPL. The results support the hypothesis that motor cortex areas can be functionally involved and likely play a role in motor circuit dysfunction in MSA patients.
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Affiliation(s)
- Hui You
- Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
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Abstract
Multiple system atrophy (MSA) is a rare neurodegenerative disorder without any effective treatment in slowing or stopping disease progression. It is characterized by poor levodopa responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. However, symptomatic management remains disappointing and no curative treatment is yet available. Recent experimental evidence has confirmed the key role of alpha-synuclein aggregation in the pathogenesis of MSA. Referring to this hypothesis, transgenic and toxic animal models have been developed to assess candidate drugs for MSA. The standardization of diagnosis criteria and assessment procedures will allow large multicentre clinical trials to be conducted. In this article we review the available symptomatic treatment, recent results of studies investigating potential neuroprotective drugs, and future approaches for the management in MSA.
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Affiliation(s)
- Olivier Flabeau
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
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Köllensperger M, Geser F, Ndayisaba JP, Boesch S, Seppi K, Ostergaard K, Dupont E, Cardozo A, Tolosa E, Abele M, Klockgether T, Yekhlef F, Tison F, Daniels C, Deuschl G, Coelho M, Sampaio C, Bozi M, Quinn N, Schrag A, Mathias CJ, Fowler C, Nilsson CF, Widner H, Schimke N, Oertel W, Del Sorbo F, Albanese A, Pellecchia MT, Barone P, Djaldetti R, Colosimo C, Meco G, Gonzalez-Mandly A, Berciano J, Gurevich T, Giladi N, Galitzky M, Rascol O, Kamm C, Gasser T, Siebert U, Poewe W, Wenning GK. Presentation, diagnosis, and management of multiple system atrophy in Europe: final analysis of the European multiple system atrophy registry. Mov Disord 2011; 25:2604-12. [PMID: 20922810 DOI: 10.1002/mds.23192] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 04/27/2009] [Accepted: 03/22/2010] [Indexed: 12/16/2022] Open
Abstract
Multiple system atrophy (MSA) is a Parkinson's Disease (PD)-like α-synucleinopathy clinically characterized by dysautonomia, parkinsonism, cerebellar ataxia, and pyramidal signs in any combination. We aimed to determine whether the clinical presentation of MSA as well as diagnostic and therapeutic strategies differ across Europe and Israel. In 19 European MSA Study Group centres all consecutive patients with a clinical diagnosis of MSA were recruited from 2001 to 2005. A standardized minimal data set was obtained from all patients. Four-hundred thirty-seven MSA patients from 19 centres in 10 countries were included. Mean age at onset was 57.8 years; mean disease duration at inclusion was 5.8 years. According to the consensus criteria 68% were classified as parkinsonian type (MSA-P) and 32% as cerebellar type (MSA-C) (probable MSA: 72%, possible MSA: 28%). Symptomatic dysautonomia was present in almost all patients, and urinary dysfunction (83%) more common than symptomatic orthostatic hypotension (75%). Cerebellar ataxia was present in 64%, and parkinsonism in 87%, of all cases. No significant differences in the clinical presentation were observed between the participating countries. In contrast, diagnostic work up and therapeutic strategies were heterogeneous. Less than a third of patients with documented orthostatic hypotension or neurogenic bladder disturbance were receiving treatment. This largest clinical series of MSA patients reported so far shows that the disease presents uniformly across Europe. The observed differences in diagnostic and therapeutic management including lack of therapy for dysautonomia emphasize the need for future guidelines in these areas.
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Brown RG, Lacomblez L, Landwehrmeyer BG, Bak T, Uttner I, Dubois B, Agid Y, Ludolph A, Bensimon G, Payan C, Leigh NP. Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy. Brain 2010; 133:2382-93. [PMID: 20576697 DOI: 10.1093/brain/awq158] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard G Brown
- King's College London, MRC Centre of Neurodegeneration Research, Institute of Psychiatry, Department of Psychology, PO77, London SE5 8AF, UK.
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Abstract
Multiple system atrophy (MSA) is a rare late onset neurodegenerative disorder which presents with autonomic failure and a complicated motor syndrome including atypical parkinsonism, ataxia and pyramidal signs. MSA is a glial alpha-synucleinopathy with rapid progression and currently poor therapeutic management. This paper reviews the clinical features, natural history and novel diagnostic criteria for MSA as well as contemporary knowledge on pathogenesis based on evidence from neuropathological studies and experimental models. An outline of the rationale for managing symptomatic deterioration in MSA is provided together with a summary of novel experimental therapeutic approaches to decrease disease progression.
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Affiliation(s)
- Gregor K Wenning
- Section of Clinical Neurobiology, Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Chang CC, Chang YY, Chang WN, Lee YC, Wang YL, Lui CC, Huang CW, Liu WL. Cognitive deficits in multiple system atrophy correlate with frontal atrophy and disease duration. Eur J Neurol 2009; 16:1144-50. [PMID: 19486137 DOI: 10.1111/j.1468-1331.2009.02661.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Dementia remains an exclusion criterion in diagnosing multiple system atrophy (MSA). This study aimed to determine the cognitive changes and brain atrophy patterns in the Parkinsonian (MSA-P) and cerebellar (MSA-C) variants of MSA. METHODS Voxel-based morphometry (VBM) of magnetic resonance imaging (MRI) and neuro-psychological tests were applied to 10 MSA-C and 13 MSA-P patients, and compared to 37 age-matched controls. Correlation analyses were performed between cognitive test results and morphometric data extracted from the VBM data. RESULTS In neuro-psychological testing, the 23 MSA patients scored lower in the Stroop interference test and took longer in the trail-making test as compared with the controls, whereas MSA-C performed worse than MSA-P in the memory scores, Stroop test, and time to complete the trail-making test. MSA, as a group, showed atrophy in the cerebellum, insular cortex, fusiform gyrus, inferior orbito-frontal gyrus, superior temporal gyrus, and caudate nucleus. Memory scores correlated well with pre-frontal lobe atrophy but not in the insular area. CONCLUSION In conclusion, although dementia is not a typical presenting feature of MSA and is regarded as a sub-cortical movement disorder, frontal atrophy, cognitive changes, and dementia are identifiable as MSA progresses.
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Affiliation(s)
- C C Chang
- Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Krim E, Tison F. Atrofia multisistemica. Neurologia 2009. [DOI: 10.1016/s1634-7072(09)70517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sitburana O, Ondo WG. Brain magnetic resonance imaging (MRI) in parkinsonian disorders. Parkinsonism Relat Disord 2008; 15:165-74. [PMID: 19059803 DOI: 10.1016/j.parkreldis.2008.04.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 04/10/2008] [Accepted: 04/20/2008] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging (MRI) is increasingly integrated into neurological diagnostics. In addition to functional MRI, a large number of sequences (T1W, T2W, PD, T2W gradient echo, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI)), investigate CNS abnormalities. Objective quantification techniques (T1W voxel-based morphometry) can also discern subtle anatomical differences. Parkinsonian conditions such as Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and manganese-induced parkinsonism can clinically overlap, yet have very different prognoses and treatments. Relatively little radiographic interest has focused on movement disorders. Nevertheless in the past decade, a variety of findings, often subtle and routinely overlooked, have emerged to help the clinician differentiate these conditions. This review will summarize and discuss MRI findings in parkinsonian conditions. Most data concern either structural abnormalities or the imaging sequelae of abnormal iron deposition, common in some parkinsonian conditions.
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Affiliation(s)
- Oraporn Sitburana
- Neurology Center, Bumrungrad International Hospital, 33 Sukhumvit 3, Bangkok 10110, Thailand.
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Bensimon G, Ludolph A, Agid Y, Vidailhet M, Payan C, Leigh PN. Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: the NNIPPS study. ACTA ACUST UNITED AC 2008; 132:156-71. [PMID: 19029129 PMCID: PMC2638696 DOI: 10.1093/brain/awn291] [Citation(s) in RCA: 250] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Parkinson plus diseases, comprising mainly progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are rare neurodegenerative conditions. We designed a double-blind randomized placebo-controlled trial of riluzole as a potential disease-modifying agent in Parkinson plus disorders (NNIPPS: Neuroprotection and Natural History in Parkinson Plus Syndromes). We analysed the accuracy of our clinical diagnostic criteria, and studied prognostic factors for survival. Patients with an akinetic-rigid syndrome diagnosed as having PSP or MSA according to modified consensus diagnostic criteria were considered for inclusion. The psychometric validity (convergent and predictive) of the NNIPPS diagnostic criteria were tested prospectively by clinical and pathological assessments. The study was powered to detect a 40% decrease in relative risk of death within PSP or MSA strata. Patients were randomized to riluzole or matched placebo daily and followed up to 36 months. The primary endpoint was survival. Secondary efficacy outcomes were rates of disease progression assessed by functional measures. A total of 767 patients were randomized and 760 qualified for the Intent to Treat (ITT) analysis, stratified at entry as PSP (362 patients) or MSA (398 patients). Median follow-up was 1095 days (range 249–1095). During the study, 342 patients died and 112 brains were examined for pathology. NNIPPS diagnostic criteria showed for both PSP and MSA excellent convergent validity with the investigators’ assessment of diagnostic probability (point-biserial correlation: MSA rpb = 0.93, P< 0.0001; PSP, rpb = 0.95, P< 0.0001), and excellent predictive validity against histopathology [sensitivity and specificity (95% CI) for PSP 0.95 (0.88–0.98) and 0.84 (0.77–0.87); and for MSA 0.96 (0.88–0.99) and 0.91 (0.86–0.93)]. There was no evidence of a drug effect on survival in the PSP or MSA strata (3 year Kaplan–Meier estimates PSP-riluzole: 0.51, PSP-placebo: 0.50; MSA-riluzole: 0.53, MSA-placebo: 0.58; P = 0.66 and P = 0.48 by the log-rank test, respectively), or in the population as a whole (P = 0.42, by the stratified-log-rank test). Likewise, rate of progression was similar in both treatment groups. There were no unexpected adverse effects of riluzole, and no significant safety concerns. Riluzole did not have a significant effect on survival or rate of functional deterioration in PSP or MSA, although the study reached over 80% power to detect the hypothesized drug effect within strata. The NNIPPS diagnostic criteria were consistent and valid. They can be used to distinguish between PSP and MSA with high accuracy, and should facilitate research into these conditions relatively early in their evolution.
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Affiliation(s)
- Gilbert Bensimon
- Département de Pharmacologie Clinique, Hôpital de la Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris & UPMC University Paris 06, UMR 7087, Paris, France
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Köllensperger M, Geser F, Seppi K, Stampfer-Kountchev M, Sawires M, Scherfler C, Boesch S, Mueller J, Koukouni V, Quinn N, Pellecchia MT, Barone P, Schimke N, Dodel R, Oertel W, Dupont E, Østergaard K, Daniels C, Deuschl G, Gurevich T, Giladi N, Coelho M, Sampaio C, Nilsson C, Widner H, Sorbo FD, Albanese A, Cardozo A, Tolosa E, Abele M, Klockgether T, Kamm C, Gasser T, Djaldetti R, Colosimo C, Meco G, Schrag A, Poewe W, Wenning GK. Red flags for multiple system atrophy. Mov Disord 2008; 23:1093-9. [PMID: 18442131 DOI: 10.1002/mds.21992] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The clinical diagnosis of multiple system atrophy (MSA) is fraught with difficulty and there are no pathognomonic features to discriminate the parkinsonian variant (MSA-P) from Parkinson's disease (PD). Besides the poor response to levodopa, and the additional presence of pyramidal or cerebellar signs (ataxia) or autonomic failure as major diagnostic criteria, certain other clinical features known as "red flags" or warning signs may raise the clinical suspicion of MSA. To study the diagnostic role of these features in MSA-P versus PD patients, a standardized red flag check list (RFCL) developed by the European MSA Study Group (EMSA-SG) was administered to 57 patients with probable MSA-P and 116 patients with probable PD diagnosed according to established criteria. Those red flags with a specifity over 95% were selected for further analysis. Factor analysis was applied to reduce the number of red flags. The resulting set was then applied to 17 patients with possible MSA-P who on follow-up fulfilled criteria of probable MSA-P. Red flags were grouped into related categories. With two or more of six red flag categories present specificity was 98.3% and sensitivity was 84.2% in our cohort. When applying these criteria to patients with possible MSA-P, 76.5% of them would have been correctly diagnosed as probable MSA-P 15.9 (+/-7.0) months earlier than with the Consensus criteria alone. We propose a combination of two out of six red flag categories as additional diagnostic criteria for probable MSA-P.
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Affiliation(s)
- Martin Köllensperger
- Section for Clinical Neurobiology, Department of Neurology, Innsbruck Medical University, Austria
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Abstract
BACKGROUND It has been almost 4 decades since the descriptions of the 3 parts of multiple system atrophy (MSA) have taken place, characterized clinically by dysautonomia, parkinsonism, and cerebellar dysfunction. The discovery of a distinctive pathologic maker has finally provided the conceptual synthesis of these 3 entities into the universal designation of MSA as a distinct disease process with a complex combination of clinical presentations. Although advances have been made in terms of awareness and knowledge concerning the clinical features and pathophysiology of MSA, it remains challenging for neurologists who treat these patients to differentiate MSA from its mimics as well as providing them with effective treatment. REVIEW SUMMARY The aim of this review is to provide an overview of the advances in the knowledge of the disease, to highlight typical features useful for the recognition of its entity, and to enlist different treatment options. CONCLUSION Despite the fact that there is still no treatment modality that can alter the disease progression, a number of useful symptomatic treatment measures are available and should be offered to patients to ameliorate the nonmotor features of MSA and even the motor features that may at least transiently respond to treatment.
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